Engaging clients to be active participants in their own intervention is a cornerstone of occupational therapy.1 A challenge with pediatric clients is that the child often is tired of working hard all the time and just wants to play.
The desire to play and have fun is natural and understandable but there are practical considerations too. The child is in therapy for goals that require work such as independence in ADLs, writing, cutting, chores, etc. Since many children cannot understand how important these needs are, they may not cooperate in addressing them. In the worst case, a child may actively resist therapy.
Making therapeutic work fun requires creative clinical reasoning on the part of occupational therapy practitioners.4
Use Strengths: Interests and Abilities
We all get discouraged when a pediatric client isn’t interested. However, when we take a step back, we can find activities the child can do and wants to do.6-9 These interests and abilities are strengths that can provide a foundation for engaging clients and is supported as an evidence-based practice for children with ASD.2,3,10,11
For example, if a child is interested in superheroes, clients can pretend to be fighting bad guys, rescuing good guys, or training to be superheroes (AKA exercises). If a child likes the color orange, then orange ribbon, paper, markers, and toys can be incorporated into many activities. If a child is good at reading, steps or concepts can be written down on cards with therapeutic activities. If a child has a wealth of knowledge about animals, the child can share this information while doing motor activities. All strengths have potential to motivate engagement in occupational therapy.10
Recreate Activities: Same, but Different
Sometimes, including a single interest is not enough to engage the child in the therapeutic activity. The same activity, performed in the same way, does not work for all clients. Nonetheless, the same therapeutic activity can potentially meet the needs of multiple clients if each participates.
When a child does not participate, then we can recreate the activity so that the child will participate.4,5 We can redesign the activity into one that is fun and that the child wants to do by modifying aspects of the activity:
- Sensory features
- Required motor actions
- Social factors
- Cognitive components
Using multiple strengths and interests in each of these areas can enhance the child’s willingness to participate in therapy. The core activity remains the same and retains its therapeutic essence, but the activity is seen differently by the client.4,8,9
Occupational therapy becomes fun and motivating for pediatric clients when their interests and strengths are included. They move from disinterest to interest. Once engaged, a child develops skills. With skills, the child gains new abilities that encourage further engagement in therapy often with lessening customization from us.
- American Occupational Therapy Association (2014) Occupational therapy practice framework: Domain and process (3rd ed ) American Journal of Occupational Therapy, 68(Suppl 1), S1– S48 http://dx doi org/10 5014/ajot 2014 682006
- Dunst, C. J., Trivette, C. M., & Hamby, D. W. (2012). Meta-Analysis of Studies Incorporating the Interests of Young Children with Autism Spectrum Disorders into Early Intervention Practices. Autism Research and Treatment, 2012, 462531. http://doi.org/10.1155/2012/462531
- Gunn, K.C.M., & Delafield-Butt, J. T. (2015). Teaching Children With Autism Spectrum Disorder With Restricted Interests: A Review of Evidence for Best Practice, Review Of Educational Research.
- Kuhaneck, H.M., Spitzer, S. L., & Miller, E. (2010). Activity Analysis, Creativity, and Playfulness in Pediatric Occupational Therapy: Making Play Just Right. Boston, MA: Jones and Bartlett Publishers, LLC.
- Munier, V., Myers, C. T., & Pierce, D. (2008). Power of object play for infants and toddlers. In L. D. Parham & L. S. Fazio (Eds.), Play in occupational therapy for children (2nd ed., pp. 219–249). St. Louis, MO: Mosby Elsevier.
- Spitzer, S. L. (2003a). Using participant observation to study the occupations of young children with autism and other developmental disabilities. American Journal of Occupational Therapy, 57(1), 66-76.
- Spitzer, S. L. (2003b). With and without words: Exploring occupation in relation to young children with autism. Journal of Occupational Science, 10 (2), 67-79.
- Spitzer, S. L. (2008). Play in children with autism: Structure and experience. In L. D. Parham & L. S. Fazio (Eds.), Play in Occupational Therapy for Children (2nd ed., pp. 351-374). St. Louis, MO: Mosby Elsevier.
- Spitzer, S. L. (2010). Common and Uncommon Daily Activities in Children with an Autism Spectrum Disorder: Challenges and Opportunities for Supporting Occupation. In H. Miller Kuhaneck & R. Watling (Eds.), Autism: A Comprehensive Occupational Therapy Approach (3rd ed., pp. 203-233). Bethesda, MD: American Occupational Therapy Association.
- Tomchek, S. D., & Koenig, K. P. (2016). Occupational therapy practice guidelines for individuals with autism spectrum disorder. Bethesda, MD: AOTA Press.
- Winter-Messiers, M. (2007). From tarantulas to toilet brushes: Understanding the special interest areas of children and youth with Asperger's syndrome. Remedial and Special Education, 28, 140-152.